NONSTEROIDAL ANTIINFLAMMATORY DRUGS FOR CANCER PAIN - COMPARISON BETWEEN MISOPROSTOL AND RANITIDINE IN PREVENTION OF UPPER GASTROINTESTINALDAMAGE

Purpose: The prophylactic strategy of nonsteroidal antiinflammatory dr ug (NSAID)-induced upper gastrointestinal (UGI) damage has largely bee n studied in arthritic patients, but not in cancer patients. The effic acy of misoprostol and ranitidine in the prevention of gastroduodenal damage in patients taking diclofenac for their cancer pain has been co mpared in this study. Patients and Methods: Patients who needed high-d ose (200 to 300 mg/d) diclofenac for cancer pain and without mucosal l esions at baseline gastroduodenal endoscopy were randomized to receive misoprostol (200 mu g twice daily; M group) or ranitidine (150 mg twi ce daily; R group). UGI endoscopy was repeated after 4 weeks. Results: Twenty-three patients treated with misoprostol and 26 treated with ra nitidine concluded the study. The M group showed a significantly (P < .02) lower incidence of gastroduodenal lesions (two patients; 8.7%) th an the R group (10 patients; 38.5%), Gastric ulcers occurred in one (4 %) misoprostol-treated patient and in six (23%) ranitidine-treated pat ients. Six of seven patients with ulcers were asymptomatic. Seventy-on e percent and 86% of ulcers occurred in patients older than 60 years a nd in those who received greater than 3.1 mg/kg of diclofenac, respect ively. Conclusion: Misoprostol was significantly more effective than r anitidine in the prevention of gastroduodenal lesions in cancer patien ts receiving diclofenac. (C) 1995 by American Society of Clinical Onco logy.